Colorectal cancer in nonagenarians

The aim of the study was to analyze the short-term and long-term outcomes of nonagenarians treated for colorectal cancer.

A retrospective analysis was performed of 74 patients, ≥ 90 years of age, diagnosed with colorectal cancer during the period 1986-2009. Comorbidity, American Society of Anesthesiology (ASA) grade, symptoms, diagnosis, treatment, mortality, morbidity and survival were analyzed.

Of the 74 patients, 48 (65%) were women. Twenty-two patients were classified as ASA grade I-II, 26 as ASA grade III and 26 as ASA grade IV-V. Thirty-one (42%) had intestinal obstruction at the time of diagnosis. Twenty-two (30%) patients were diagnosed during the period 1986-2000 and 52 (70%) were diagnosed between 2001 and 2009. Forty-four (59%) patients underwent surgery, of whom 19 (49%) were treated as an emergency. Eleven (25%) patients died postoperatively, with mortality rates of 12% (3/25) for elective surgery and 42% (8/19) for emergency surgery. Surgical mortality for ASA grade I and grade II patients was 5% (1/20) and their 5-year survival rate (postoperative mortality excluded) was 44%, whereas 5-year survival for ASA grade III patients who underwent surgery was 12.5% and surgical mortality was 25% (4/16). There were no survivors beyond 36 months among patients who did not receive surgery.

Our results indicate that elective and emergency colorectal surgery can be performed with acceptable rates of mortality and morbidity on nonagenarian patients in good general condition with low perioperative risk. The 5-year survival rate was related to ASA grade and to the use of surgery.